CDC Reports COVID-19 has Disparate Impact on Minorities including American Indians and Alaska Natives

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A Centers for Disease Control (CDC) report presented to lawmakers revealed the disparate impact that COVID-19 is having on racial and ethnic minorities. The report found that while African Americans make up 13% of the U.S. population, they constitute 27% of all coronavirus cases. Hispanic or Latino Americans constitute 28% of all cases, while making up only 18% of the U.S. population. While the rate of infection varies among the American Indian/Alaska Native population, the Navajo Nation currently has the highest per-capita infection rate of COVID-19 in the United States. This demographic data is not complete as it has only been available in 47.9% of cases.

These racial disparities and lack of comprehensive demographic data have caught the attention of Rep. Rosa DeLauro (D-Conn.). Rep. DeLauro serves as the Chairwoman of the House Appropriations HHS and Education Subcommittee. She told reporters that she wanted more funding to be appropriated to address and get more information on these health disparities. “I will continue to push for funding to reduce health disparities in subsequent relief packages as well as in the appropriations bill which we will begin to write for 2021,” Rep. DeLauro said. According to Rep. DeLauro, it would take approximately $750 million over a few years in order to get quality health data. The CARES Act, which was passed in response to the pandemic, allocated $500 million for public health surveillance and analytics.

Throughout the pandemic, NCUIH has fought to obtain access to coronavirus funding for UIOs in order to ensure that American Indians and Alaska Natives are not left behind during this crisis.

HHS Publishes Revised AFCARS Final Rule Streamlining ICWA-related Reporting

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On May 12, 2020 the Department of Health and Human Services (HHS) published a final rule with revisions to the Adoption and Foster Care Analysis Reporting System (AFCARS) regulations. The streamlined final rule will lessen the AFCARS data-reporting requirements for Title IV-E agencies.

The expanded 2016 AFCARS regulations covered Indian Child Welfare Act of 1978 (ICWA)-related data elements to be reported to HHS. The streamlined rule asked Title IV-E agencies to report if a child is an Indian child as defined by ICWA, if the child is a tribal member, of which tribe a child is a member of, and if the ICWA applies to the child, was the tribe sent legal notice. No other ICWA-related data elements are to be reported.

The National Council of Urban Indian Health submitted comments on the potential rule change, as did Tribes and tribal organizations. Commenters with tribal interests did not support reduction in the data elements of required reporting and requested all ICWA-related data elements be reinstated from the 2016 Final Rule as they are needed to assess ICWA compliance. The commenters also claimed the data helps to address disparities and analyze outcomes for Indian children and families.

The Administration for Children and Families (ACF) explained the reduction in the ICWA-related data elements was recommended due to the low population of American Indian/ Alaska Native children in foster care. ACF further explained that DOI is the lead agency for all ICWA compliance and the 2016 ICWA-related data elements place HHS in a position of interpreting ICWA requirements without having the authority to do so. The only authority they have is over the collection data elements related to the Title IV-E programs.

The rule will go into effect on July 13, 2020.

IHS Announces Phase 4 COVID-19 Funding Allocation Decisions

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Includes $50 million to UIOs for testing

On May 19, 2020 the Indian Health Service (IHS) announced the most recent round of COVID-19 funding determinations in a Dear Tribal Leader and Urban Indian Organization Leader Letter (DULL).  The DULL outlines the total allocations for the $750 million appropriation for Indian Country Health Care Providers in the Paycheck Protection Program and Health Care Enhancement Act (PPPHCEA).  The Act was signed into law on April 24, 2020 and provided the funding to the Department of Health and Human Services (HHS) under the Public Health and Social Services Emergency Fund, to be used in support of testing and testing related activities for Tribal Health Programs (THPs) and Urban Indian Organizations (UIOs).

IHS’s funding determinations include $50 million for UIOs, which will be distributed through the existing Indian Health Care Improvement Act (IHCIA) contracts. As outlined in the Act, the funds are to be used for the purchase, administration, process, and analysis of COVID-19 testing, including the support for workforce, epidemiology, and use by employers in other settings. UIOs IHCIA contracts will receive modified scopes of work and bilateral modifications to their IHCIA contracts consistent with the funding purposes for which the funds were appropriated.

Other funding determinations announced in the DULL include $550 million to IHS Federal health programs and THPs, of which $50 million is to be used for new Purchased/ Referred Care (PRC) funds. $100 million will be used to purchase tests, testing supplies, and PPE for the IHS National Supply Service Center (NSSC). UIOs are eligible to receive supplies from the NSSC. The final $50 million is allocated for nation-wide coordination, epidemiological, surveillance, and public health support.

This third round of COVID-19 funding comes after the April 29, 2020 Urban Confer and Tribal Consultation calls regarding this funding as well as weekly IHS-hosted UIO Leader COVID-19 calls advocated for by the National Council of Urban Indian Health (NCUIH). NCUIH continues to advocate on behalf of UIOs and the urban Indian populations they serve during this public health crisis.

Read the DULL

Policy Alert: NCUIH to Testify Before House Appropriations on COVID-19 Response

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The House Interior Appropriations Subcommittee will hold a hearing on Indian Health Service Covid-19 Response on Thursday, June 11 at 1:00 PM ET.

On June 11, 2020, Executive Director Francys Crevier of the National Council of Urban Indian Health (NCUIH) will testify before the House Appropriations Subcommittee on Interior, Environment, and Related Agencies. The hearing is on the COVID-19 Response and will be led by Chair Betty McCollum and Ranking Member David Joyce.

Watch the hearing live here.

Witnesses

Panel one

Rear Adm. Michael D. Weahkee
Director, Indian Health Service

Panel two

Stacey Bohlen
Chief Executive Officer, National Indian Health Board

Francys Crevier
Executive Director, National Council of Urban Indian Health

NCUIH FACILITATES FIRST FEMA UIO LEADERS CALL

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On May 29, for the first time, the Federal Emergency Management Agency (FEMA) met exclusively with a group of Urban Indian Organization (UIO) leaders. The call took place via Zoom video conference. The purpose of the call was to provide UIOs an opportunity to learn about programs open to nonprofits, get questions answered, and open the lines of communication with FEMA officials. FEMA is one of the major operational components that make up the Department of Homeland Security, which is facilitating a whole-of-government response in confronting COVID-19, keeping Americans safe, and helping detect and slow the spread of the virus.

The following officials from FEMA participated in the call: Acting Director Public Assistance Division Tod Wells; Attorney-Advisor, Federal Indian Law Subject Matter Expert Dorn Lawin; Tribal Affairs Specialist Margeau Valteau; and Tribal Integration Advisor Jessica Specht. Dr. Rose Weahkee, Director of the Office of Urban Indian Health Programs at the Indian Health Service, was also in attendance. FEMA sent NCUIH responses to the questions UIO leaders asked in a document that can be found here.

House and Senate Leaders Send Letters of Support for Emergency Third-Party Reimbursement Fund for Indian Health Care Providers, Including UIOs

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On May 5, 2020, Senators Kamala Harris (D-CA), Dianne Feinstein (D-CA), and Tom Udall (D-NM) and Representatives Markwayne Mullin (R-OK), Raul Ruiz (D-CA) led 55 of their colleagues in letters to Senate and House leadership requesting additional funding for third-party reimbursement losses for Indian Health Service facilities, Tribal Health Programs, and UIOs.

The letters highlight that third-party reimbursement is essential for the I/T/U system and losses in those funds are only exacerbating funding gaps and other issues facilities face during the pandemic.  The letters were finalized before the most recent phase of COVID-19 legislation, which was released on May 12 by the House of Representatives.

House Letter
Senate Letter

Sen. Harris Announces Legislation to Establish COVID-19 Racial and Ethnic Disparities Task Force with a UIO Representative

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On April 30, 2020 Senator Kamala Harris announced she will introduce new legislation to combat racial and ethnic disparities during the COVID-19 pandemic. The COVID-19 Racial and Ethnic Disparities Task Force Act would create a task force designed to provide Congress and the Federal Emergency Management Agency (FEMA) with weekly recommendations on COVID-19 resource allocations according to racially disaggregated data, provide oversight and recommendations for federal agencies on COVID-19 relief funds, and report on structural inequalities before and in-response to COVID-19. The task force, following the COVID-19 public health crisis, would then become an Infectious Disease Racial Disparities Task Force.

The task force legislation is in response to many accounts of major racial disparities during this pandemic, including the health disparities American Indians and Alaska Natives (AI/ANs) are facing. To this end, the task force is set to include one representative on behalf of Urban Indian Organizations (UIOs) and Urban Indians. On May 8, 2020 Representative Robin Kelly (D-IL) introduced companion legislation in the House, H.R. 6763.

Learn More

Centers for Disease Control Releases Guidance on Reopening

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On Thursday, May 14, 2020, the Centers for Disease Control (CDC) released guidance on reopening businesses, communities, schools, camps, daycares and mass transit. Previous guidelines were withheld by the Trump administration because they were deemed “too prescriptive” and restricted states that desired to reopen. The unreleased document was created by the nation’s top disease investigators with step-by-step advice to local authorities on how and when to reopen public places during the coronavirus outbreak. This report, titled Guidance for Implementing the Opening Up America Again Framework, was researched and written to help faith leaders, business owners, educators and state and local officials as they begin to reopen. This report was not released by the administration but was obtained by the Associated Press.

The new CDC released report provides a series of one page checklists which are designed to provide guidance to communities as they reopen. These checklists do not provide specific advice on when to reopen, rather they present a series of questions for employers to ask before they reopen. The checklists encourage social distancing, cleaning, monitoring of employee symptoms, flexible sick leave policies, the use of masks, as well as other suggestions. The guidance defers to state timelines on reopening. The more relaxed CDC guidelines were released amidst Dr. Anthony Fauci’s warnings that reopening the country too early could yield “really serious” consequences if states don’t have the capacity to respond to new infections.

Read More

Senator Warren and Representative Levin Introduce Legislation That Would Establish a National Contact Tracing Program including UIOs

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On Thursday, May 14, 2020, Senator Elizabeth Warren (D-Mass) and Representative Andy Levin (D-Mich) introduced the Coronavirus Containment Corps Act. The Coronavirus Containment Corps Act was co-sponsored by Sens. Tina Smith (D-Minn.) and Jeff Merkley (D-Ore.).The legislation would establish a federal coronavirus contact tracing program.  Sen. Warren and Rep. Levin would like the legislation to be incorporated into any future coronavirus relief packages.

The bill would require the Center for Disease Control (CDC) to develop a national strategy for coronavirus contact tracing within 21 days after coordinating with state, local, and Tribal health officials. The bill would require the Director of the CDC to coordinate with the Director of the Indian Health Service (IHS) to ensure the contact tracing needs of Indian Tribes are met. The legislation would provide states and Tribes with $10 billion for hiring contact tracers and other staff. It would also provide states and Tribes with $500 million to find those who have lost their jobs during the coronavirus and prioritize their hiring as contact tracers. In addition, the legislation will ensure patient privacy by requiring the CDC to anonymize data, automatically delete patient data, and prohibit data-sharing within the federal government except within the CDC and IHS. Tribal health data sovereignty would also be protected by the proposed legislation.

The bill also provides grants to Indian Tribes, Tribal organizations, Alaska Native entities, Indian controlled organizations serving Indians, Urban Indian organizations, or Native Hawaiian organizations. The purpose of these grants will bethe recruitment, placement, and training of individuals seeking employment in contact tracing and related positions.

Contact tracing will help mitigate the transmission of COVID-19 by identifying all individuals who have been in contact with someone who tested positive with coronavirus. These potentially infected individuals are then tested for coronavirus and encouraged to quarantine if they test positive.

The Coronavirus Containment Corps Act would be a significant step forward in ensuring the health of the American Indian/Alaska Native (AI/AN) Population during this pandemic. The legislation also helpsUrban Indian Organizationsby making them eligible for grants to promote job opportunities for Urban Indians as contact tracers.

CMS Issues Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency

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This interim final rule with comment period (IFC) instituted by the Centers for Medicare & Medicaid Services (CMS) has instated several Medicare policies on an interim basis. These policies have authorized COVID-19 serology tests, to allow any healthcare professional authorized under State law to order COVID-19 diagnostic laboratory tests and provides new specimen collection fees for COVID-19 testing under the Physician Fee Schedule and Outpatient Prospective Payment System, during the public health emergency (PHE) for the COVID-19 pandemic.  CMS also adopted a relocation exception policy for on-campus and excepted off-campus provider-based departments of hospitals that relocate in response to the PHE.

In addition, CMS updated the Extraordinary Circumstances Exceptions policy under the Hospital Value-based Purchasing (VBP) Program to grant an exception to hospitals affected by an extraordinary circumstance without a request form, and granted exceptions under the updated policy to all hospitals participating in the Hospital VBP Program with respect to certain 4th quarter 2019 measure data that hospitals would otherwise be required to report in April or May of 2020, and measure data that hospitals would otherwise be required to collect during the 1st and 2nd quarters of 2020. Additionally, in response to the PHE, CMS is incorporating changes for Accountable Care Organizations participating in the Medicare Shared Savings Program by delaying 1 year the implementation of certain qualified clinical data registry measure approval criteria under the Quality Payment Program’s Merit-based Incentive Payment System.

This IFC also allows states operating a Basic Health Program (BHP) to seek certification of a revised BHP Blueprint for temporary, significant changes that are directly tied to the COVID-19 pandemic. CMS has also issued a waiver of the “3-hour rule” required by section 3711(a) of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), as well as modifying the coverage and classification requirements for freestanding hospitals to exclude patients admitted solely to relieve acute care hospital capacity in a state that is experiencing a surge during the PHE.  In addition, CMS is making changes to the Medicare regulations to revise payment rates for certain durable medical equipment and enteral nutrients, supplies, and equipment as part of implementation of section 3712 of the CARES Act.   The policies in this IFC are applicable beginning on March 1, 2020 or January 27, 2020, depending on the policy.